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The Act to Regulate the Practice of Medicine in the State of California

The Act to Regulate the Practice of Medicine in the State of California

The Act requires that each State Medical Society incorporated and in active existence on 10 March 1876, whose members are required to possess diplomas or licenses from some legally chartered medical institution in good standing, shall appoint annually, a Board of Examiners consisting of seven members; who shall hold their office for one year, and until their successors shall be chosen.

The Act further provides that every medical graduate practicing medicine in the State shall present his diploma to the Board of Examiners for verification as to its genuineness. If the diploma is found genuine, the Board shall issue its certificate to that effect. A diploma and certificate are required for the lawful practice of medicine in the State.

If not a medical graduate, the person practicing medicine in the State shall present himself before the Board, and submit himself to such examinations as the Board shall require; and if the examination be satisfactory to the examiners, the Board shall issue its certificate in accordance with the facts, and the lawful holder of such certificate shall be entitled to all the rights and privileges mentioned in the Act. But no examination into the qualifications of persons not holding diplomas or licenses shall be made after 31 December 1876. After this date no certificates shall be granted by the Board except to persons presenting diplomas or licenses from legally chartered medical institutions in good standing.

(This provision for certification by examination was inserted to provide a strictly limited period during which "old-timers," who held no diploma but had proven competent in practice, might obtain a certificate if able to pass examination by the Board.)

Any person practicing medicine or surgery in this State without complying with the provisions of this Act, shall be punished by a fine of not less thant fifty dollars ($ 50) nor more than five hundred dollars ($ 500), or by imprisonment in the County Jail for a period of not less than thirty days nor more than three hundred and sixty-five days, or by both such fine and imprisonment, for each and every offense.

(This original Medical Practice Act, with minor revisions made in 1878, remained in effect and unchanged in form until 1901.)

Nothing in the Act prevented Homeopathic physicians and Eclectic physicians from organizing State Societies and appointing Boards of Examiners in like manner to the California State Medical Society for "regular physicians." This option was initially considered by regular physicians to be an objectionable feature of the Act, but when the Homeopathic and Eclectic Boards proved diligent in rooting out the blatant quacks in their own ranks, the regular physicians were mollified.

The above Act as finally adopted was the result of five years of study and debate in the Legislature, involving many individuals and organizations, including Dr. Logan and the State Medical Society who, as we have seen, were late in taking an active interest in the formulation of the bill. It is sad to report that Dr. Logan, the leading medical statesman of California in his era, was not to be rewarded by seeing the approved version of the legislation. He died on 13 February 1876. At the time of his death he held the chair of Hygiene in the Medical Department of the University of California. [75]

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Meeting of the State Medical Society, April 1876

The Sixth Annual Meeting of the State Medical Society met on April 19th and 20th in San Francisco. We take special note of the following two significant actions of the Society.

First, the Society voted to admit women holding valid medical diplomas to the State Society on the same basis as men. Five women were duly elected to membership (three from San Francisco, one from Oakland and one from San Jose). A male member of the Society wrote a strong letter of objection to the Editor of the PMSJ. To which Dr. Gibbons replied: [76] [77]

As for the argument of our correspondent against admitting females to membership, we will leave it to have its full weight with the reader, simply remarking that if women "cannot" practice medicine, the sooner they are allowed to try it, the sooner the question will be settled, and the sooner they will retire from the field. They are determined on the trial and we cannot prevent it. Let them show their incapacity if they are incompetent, and then we shall be done with female doctors. If they cannot stride a mustang or mend bullet holes, so much the better for enterprising and skillful practitioners of the sterner sex.

Seven weeks later, on 6 June 1876 at the Annual Meeting of the A. M. A in Philadelphia, Dr. Sarah Hackett Stevenson, delegate from the Illinois State Medical Society, became the first woman member of the A. M. A.

Second, the California State Society elected the seven members of the first Board of Examiners of the Medical Society of the State of California. Dr. Gibbons was among them. The Board was officially organized on 1 June 1876. It was announced in the PMSJ that the first meeting for examinations would be held in San Francisco on June 29th; and that meetings for the same purpose would be held subsequently at Sacramento, Chico, and Los Angeles. [78]

Dr. Gibbons, who was 68 years of age, was forced to resign from the Board of Examiners on 19 September 1876 because of illness. It was an ominous sign that his health had begun to fail. From that period until the time of his death on 5 November 1884, he was frequently unwell. [79] [80]

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State Licensing Boards Spur Reform

We now recall the Resolutions proposed by Dr. Nathan Davis and endorsed by the A. M. A. in 1869 calling upon the State medical societies of the country to establish State Boards of Medical Examiners in the hope that they would promote the reform of medical education. Eventually, this approach had the desired effect.

On 4 January 1888 the California Board of Medical Examiners took a firm step in the hoped-for direction of mandating educational reform by adopting the following resolution: [81]

Whereas, the law to regulate the practice of medicine in the State of California, provides, that the Board of Examiners in the discharge of its official duties shall determine what colleges are in good standing, whose diplomas may be presented by applicants for certificates under the law;

And, Whereas, it is apparent that the protection of the public and the best interests of the profession require a higher standard of medical education than that which is now adopted by many Colleges,

Therefore, Resolved, that on and after April 1, 1891, the Board of Examiners of the Medical Society of the State of California will not grant certificates to practise medicine on diplomas issued after that date by Colleges which do not require that all candidates for graduation shall have studied medicine not less than three full years, and shall have attended not less than three full regular courses of lectures delivered during three separate yearts.

In 1891 the National Confederation of State Licensing Boards voted to require a minimum of three years of medical training. This decision to deny licensure to laggard schools was critical. It initiated at last an appreciable nationwide movement toward reform. By 1893, 96 percent of schools required at least three years of study, and when the A. A. M. C. met in San Francisco in 1894, twenty-one of the seventy-one members voted to require a four-year medical program to be effective for the graduating class of 1899. [82]

Cooper Medical College had already implemented such a program. In the Annual Announcement for 1893, the Faculty announced "the adoption of a four years' curriculum to take effect January 1st, 1894, for all students matriculating after that date."

But much further progress nationally was still needed, particularly with respect to premedical studies and the content and methods of medical education. In his Report on Medical Education in the United States and Canada to the Carnegie Foundation in 1910, Abraham Flexner mercilessly exposed the deficiencies still existing in the programs of the generality of American medical schools, a subject to which have already briefly referred and will later return. [83]

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